Hernias: What are they and how do we treat them

A hernia is usually noticed as a lump. It appears when a portion of the tissue which lines the abdominal cavity (peritoneum) breaks through a weakened area of the abdominal wall.

How does a hernia present?A hernia usually presents as a lump which sometimes can be painful. However, it more commonly presents as a painless swelling, gradually increasing in size which is sometimes associated with mild discomfort. A hernia becomes painful if its contents become trapped (strangulated).

How is a hernia diagnosed?A hernia is diagnosed by a physical examination.

What are the sites of a hernia?The most common location for hernia is the abdomen. The abdominal wall - a sheet of tough muscle and tendon that runs down from the ribs to the legs at the groins - acts as nature's corset. Its function, amongst other things, is to hold in the abdominal contents, principally the intestines.

If a weakness should open up in that wall, the corset effect is lost and the intestines simply push through the 'window'. The ensuing bulge, which is often quite visible against the skin, is the hernia.

Basically the abdominal wall has been modified at particular sites to developmental requirements. Hernias almost exclusively occur at these well-recognized sites of weakness. Examples of these are the canals (inguinal and femoral) whichallow passage of vessels down to the scrotum and the legs, respectively. The umbilical area (navel) is another area of natural weakness frequently prone to hernia. Another area of potential weakness can be the site(s) of any previousabdominal surgery.

Groin hernias

Inguinal hernia

Femoral hernia

Scrotal hernia

Recurrent hernia

Ventral hernia

Umbilical hernia

Ventral / Epigastric hernia

Incisional hernia

Spigelian hernia

Recurrent hernia

Parastomal hernia

Who can get a hernia? Anybody, of either sex and at any age.

What causes a hernia?
The wall of the abdomen, comprising muscle and tendon, performs several functions, one of which is to provide strong support to the internal organs which are exerting significant outward pressure. The opening of a gap in the tissue can occur of its own accord at a point of natural weakness, or by over-stretching a part of the tissue. The occurrence of the gap in the abdominal wall is not normally, of itself, a problem. The problems result from the ensuing bulge of intestine through the gap. The effects felt by the patient can range from being perfectly painless, through discomfort, to being very painful indeed.

Almost every movement we make puts additional pressure on the internal tissues which, in turn, push out through the opening a little more each time. This also enlarges the opening itself. If unchecked, this process can continue even to the extent of allowing much of the intestine to hang down through the hernia.

Can hernias get better?The opening of a hernia cannot heal itself neither can any medicine be used to cure the condition. The long term course, therefore, is for a hernia to become steadily worse as time goes on, sometimes slowly and sometimes quickly. The only remedy for the condition is to repair the hernia surgically.

What kind of surgery?The operation for a groin hernia is one of the commonest surgical procedures. The standard (open) operation involves a small incision over the site of the hernia. The peritoneal bulge is returned to where it belongs and the repair is achieved by placing a piece of inert and sterile mesh in the defect in the abdominal wall. The placement of mesh seldom requires any stitching together of the muscle tissue thus eliminating the tension induced by other methods. This technique was originally devised as a much-needed alternative to re-stitching failed hernia operations (i.e. recurrences) done the old way. It was then realised that, as the technique was so successful with recurrent hernias, it should be used for 'first-time' repairs and thus avoid recurrences altogether.

In laparoscopic or keyhole surgery the operation is performed with long instruments inserted through small incisions about 1 to 1.5cms in size. A telescope inserted through one of the incisions lets the surgeon watch the operation on a TV screen. The hernia is identified and the defect repaired with mesh as in the open (non-keyhole) operation.

What is the recovery time?Naturally, the return to normal activity depends upon a number of factors. In our experience many patients are able to return to 'office' routines in about five days. You will be a little tender for the first few days but after a week or two there is no need to limit your activities, other than common sense regarding any discomfort from the wounds